Limited Opening Hours Research Articles

Factors influencing adherence to antiretroviral treatment among people living with HIV aged 15 – 60 years at Cité des Palmiers District Hospital, Cameroon

Antiretroviral therapy (ART), essential for halting the progression of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) infection and restoring immunity, should be taken regularly to be effective. This study aimed to assess the factors that may affect adherence to ART among people living with HIV (PLHIV) aged between 15 and 60 years at the Cité des Palmiers District Hospital. Thus, we conducted a descriptive and analytical cross-sectional study using a non-probabilistic, convenience survey. Data were collected using a questionnaire administered to PLHIV aged between 15 and 65 years (n = 309). These factors affecting adherence were established by determining relative and absolute frequencies, and associations were estimated by calculating the odds ratios, confidence intervals, and P-values. Subsequently, 48.5% of participants were found to comply with ART and 51.5% were not. The independent predictors of poor adherence to ART were missed appointments at the HIV unit, occasional use of excitants/cigarettes, fear of disclosing HIV status, perceived limited opening hours of HIV-related services, discomfort with medication, recent initiation of treatment, and use of therapy reminders. Our study results are essential to orient public health policies and measures toward PLHIV non-adherents to ART treatment and mitigate the social, economic, and health impact of HIV threats on developing countries by focusing on good adherence.

Physicians and nurses experiences of providing care to patients within a mobile care unit – a qualitative interview study

IntroductionThere is a growing need for alternative forms of care to address citizen demands and ensure a competent healthcare workforce across municipalities and regions. One of these forms of care is the use of mobile care units. The aim of the current study was to describe physicians and nurses experiences of providing care to patients within a mobile care unit in Sweden.MethodData were collected between March 2022 and January 2023 through qualitative interviews with 14 physicians and nurses employed in various mobile care units in different regions in Sweden. These interviews were transcribed verbatim and subjected to content analysis, with the study adhering to the Standards for Reporting Qualitative Research (SRQR).ResultsThe analysis resulted in two main categories: “Unlocking the potential of mobile care”, and “The challenges of moving hospitals to patients’ homes”; and seven subcategories. The respondents viewed mobile care at home as highly advantageous, positively impacting both patients and caregivers. They believed their contributions enhanced patients’ well-being, fostering a welcoming atmosphere. They also noted receiving more quality time for each patient, enabling thorough assessments, and promoting a person-centered approach, which resulted in more gratifying mutual relationships. However, they experienced that mobile care also had challenges such as geographical limitations, limited opening hours and logistical complexity, which can lead to less equitable and efficient care.ConclusionsPhysicians and nurses in mobile care units emphasized positive outcomes, contributing to patient well-being through a person-centered approach. They highlighted increased quality time, comprehensive assessments, and overall satisfaction, praising the mobile care unit’s unique continuity for enhancing safety and fostering meaningful relationships in the patient’s home environment. In order for mobile care to develop and become a natural part of healthcare, challenges such as geographical limitations and logistics need to be addressed.

What are the reasons for injected methadone use? A qualitative study of people who use drugs parenterally in Barcelona.

Oral methadone maintenance is a widely adopted and effective treatment for heroin and other opioid dependencies. However, injectable methadone usage may pose greater risks than heroin itself. Despite decades of oral methadone treatment in Spain, there is limited understanding of the motivations for parenteral consumption. This study aimed to examine the reasons for methadone injection, delineate its specific advantages and disadvantages compared with those of heroin use, and assess the benefits and drawbacks of supervised methadone injection within a harm reduction service from the perspective of people who inject drugs. A qualitative phenomenological study was conducted in 11 patients at a safe injection facility in Barcelona. Semistructured interviews revealed that the reasons for injecting methadone were its provision of a euphoric rush, the pleasurable sensation of needle insertion, and the avoidance of gastrointestinal discomfort associated with oral methadone use. The main attraction of methadone injection was its accessibility as a legal and fully state-funded treatment option in Spain, coupled with its effectiveness in relieving withdrawal symptoms. However, notable disadvantages included the risks inherent in injection. The benefits of supervised consumption rooms were its provision of immediate medical assistance in overdose situations, ease of access, and physical safety. Drawbacks included waiting times, limited opening hours, neighborhood stigmatization, and the distance people who inject methadone had to travel when obtaining methadone from the illicit market. Based on these findings, we make several recommendations aimed at reducing the harm associated with methadone injection and emphasize the need for comprehensive harm reduction strategies. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A multi-dimensional access index: Exploring emergency food assistance in New York City

Access to resources and services needs to be considered from a multi-dimensional perspective to capture the complex landscape of human experience. The robust body of research exploring food access has multiple limitations that create an incomplete view of food access, like studies limited to only one mode of transit and inconsistent methods across studies which limit generalizability. This study proposes a framework to formulate a multi-dimensional access index that considers travel time, operating hours, and availability of transit infrastructure across space. We use food pantries in New York City as a case study since there are relatively few of them and they have limited opening hours. We propose an index that quantifies spatiotemporal access by different modes of transportation and takes operating hours of food pantries into account during a one week time period. We compare our results to two traditional access measures and demonstrate that our index provides a significantly different measure of access. We utilize this index to highlight areas of high need but low resources, which shows the importance of this tool to policy makers and service providers. We use our experience of developing this index to highlight the challenges with quantitative analysis of human experience. Our tool is reproducible through an open-access software, which allows researchers and policy-makers to utilize it with parameters that reflect their communities.

Perspectives of Canadian Healthcare and Harm Reduction Workers on Mobile Overdose Response Services: A Qualitative Study.

Supervised consumption sites (SCS) are an evidence-based intervention proven effective for preventing drug overdose deaths. Obstacles to accessing SCS include stigma, limited hours of operation, concerns about policing, and limited geographic availability. Mobile overdose response services (MORS) are novel technologies that provide virtual supervised consumption to help reduce the risk of fatal overdoses, especially for those who use alone. MORS can take various forms, such as phone-based hotlines and mobile apps. The aim of this article is to assess the perceptions of MORS among healthcare and harm reduction staff to determine if they would be comfortable educating clients about these services. Twenty-two healthcare and harm reduction staff were recruited from Canada using convenience, snowball, and purposive sampling techniques to complete semistructured interviews. Inductive thematic analysis informed by grounded theory was used to identify main themes and subthemes. Four themes were identified: (1) increasing MORS awareness among healthcare providers was seen as useful; (2) MORS might lessen the burden of drug overdoses on the healthcare system but could also increase ambulance callouts; (3) MORS would benefit from certain improvements such as providing harm reduction resources and other supports; and (4) MORS are viewed as supplements for harm reduction, but SCS were preferred. This research provides valuable perspectives from healthcare and harm reduction workers to understand their perception of MORS and identifies key areas of potential improvement. Practical initiatives to improve MORS implementation outcomes exist.

Human Resources Management and the Impact of the Restaurant Opening Hours: An Exploratory Study

The hospitality sector is struggling with a generalized shortage of manpower to cope with the post-pandemic economic recovery. Furthermore, the work-life balance has become a very important issue when it comes to choose a place to work. This has been creating huge constraints in the hospitality industry in running and/or developing new businesses due to lack of qualified human resources. Considering the importance of this sector in the Portuguese economy, it is of paramount importance to better understand the origin of such constraints and how businesses can adapt to a new labour market reality. An exploratory study was conducted to understand how restaurant opening hours, as a top-level management decision, affects the work-life balance in the industry thus contributing to enrich the attractiveness of the jobs offered. To develop the study two groups of restaurants were studied. The first group is comprised of limited opening-hours restaurants, and the second group (as a control group), a non-limited opening hours restaurant. Semi-structured interviews were conducted with proprietors and/or top-level managers to ascertain how the decision on opening hours was weighed in the work-life balance concerns and what are the most important managerial implications, business profitability impacts, and staff retention indicators. Preliminary results seem to indicate that restaurant opening hours are one important top-level management decisions and the work-life balance has played a crucial role in the definition of the business model of the studied restaurants. By choosing limited opening hours, managers are able to schedule staff much easier and respect, as much as possible their work-life balance which then contributes to a more stable and motivated workforce. The results also show that this is only possible because restaurants manage to be profitable within the limited opening hours period. Further studies should be conducted to better understand how these new business model approaches could be used in larger-scale restaurants with non-limited opening hours.

Barriers and facilitators to vaccination in Latin America: a thematic synthesis of qualitative studies.

Vaccines are often undervalued or underused for a variety of reasons, and vaccine hesitancy is a global challenge that threatens vaccine acceptance and the goals of immunization programs. This review aimed to describe the barriers and facilitators to vaccination in Latin America. The study design was a systematic review and thematic synthesis of qualitative studies reporting on the knowledge or attitudes of adults, parents of children at vaccination age, adolescents and health professionals towards vaccination in Latin America. The databases searched were PubMed, CENTRAL, Scopus, LILACS, SciELO, and CINAHL. A total of 56 studies were included. Facilitators included vaccination being recognized as an effective strategy for preventing infectious diseases and as a requirement for access to social assistance programs, schooling or employment. Recommendations from health professionals and positive experiences with health services were also identified as facilitators. The main barriers were lack of information or counseling, structural problems such as shortages of vaccines and limited hours of operation, the inability to afford over-the-counter vaccines or transportation to health facilities, certain religious beliefs, misconceptions and safety concerns. Qualitative research can contribute to understanding perceptions and decision-making about vaccination and to designing policies and interventions to increase coverage.

Evaluation of campus public space transformation with the analytic hierarchy process (AHP) approach: A case study from Bingwen academy of southeast university, China

Changes in the prevention and control situation in the post-epidemic era have spawned a more complex campus living environment, and new space requirements have gradually formed considering interpersonal relationships and distance. The campus is a space worthy of attention and transformation as it is a densely populated space. Taking Bingwen Academy of Southeast University in China as an example, this paper describes a specific space transformation project, evaluates its main advantages and problems, and proposes some suggestions with an analytic hierarchy process. There are five assessment criteria in the space transformation: functional layout, design and materials, horticultural planting, furnishings and detail decoration, and intelligent security and management. Results show that the reformed space is a multi-functional and "living-study" physical environment. It has different usage scenarios with flexible and changeable spatial layouts and provides various activities for teachers and students with the concept of living and learning integration, co-construction, and sharing. It also promotes traditional culture and history spread through furnishings and details and educates people about morality. The reformed Bingwen Academy still has problems, such as inconvenient furniture moving, limited opening hours for all spaces, and lack of activity displacement. It is proposed to add modular furniture with rollers, manage different spaces by time, and add an achievement exhibition wall. This project provides a reference value for the space transformation of other college dormitories during and after the epidemic.

Evaluation of prolonged incubation time of 16-20 h with the EUCAST rapid antimicrobial susceptibility disc diffusion testing method.

Antimicrobial resistance rates are continuously increasing, driving the need for rapid antimicrobial susceptibility testing (RAST) results, especially in the treatment of bloodstream infections. The EUCAST RAST method performed directly from positive blood cultures with incubation times from 4 to 8 h was developed in 2018 and is now used in many laboratories. To increase the practicality of the method, an extended incubation time of 16 and 20 h was evaluated in this study. Blood culture bottles were spiked with clinical isolates (n = 325) of the seven most important sepsis pathogens. The EUCAST RAST method was performed, extending the incubation time to 16 and 20 h. Broth microdilution (BMD) was used as a reference, except for screening tests where standard disc diffusion or presence of resistance genes was used. Inhibition zones were possible to read for all species-agent combinations. For 16 and 20 h, the MIC zone diameter correlations were sufficiently similar to allow establishment of common breakpoints for the time interval of 16-20 h. The proportion of isolates in the area of technical uncertainty was, on average, 6% for all species and the number of errors were low, with <1% false-resistant and <0.5% false-susceptible results. This study shows that, for EUCAST RAST, prolonging the recommended incubation to 16-20 h is possible and can be used as a complement when the intended shorter incubation is not possible to achieve. The introduction of the prolonged incubation will increase the usefulness of the EUCAST RAST method in clinical laboratories with limited opening hours.

An integrative review of adult cancer patients’ experiences of nursing telephone and virtual triage systems for symptom management

PurposeTelephone and virtual triage services are becoming increasingly common in ambulatory oncology settings. Few studies have evaluated their implementation from the perspective of service users. This study aims to evaluate the experiences of engaging with nurse-delivered telephone and virtual triage systems for symptom management among people undergoing cancer treatment. MethodsAn integrative review was undertaken. MEDLINE, CINAHL, PsycInfo, Academic Search Complete and Scopus were systematically searched. Twelve publications met the inclusion criteria, and data related to cancer patients’ perceptions of the triage process were extracted and analysed. ResultsTelephone-based (n=7), app-based (n=5) and video-based teleconferencing (n=2) triage systems were evaluated positively overall, enhancing ease of health system navigation, avoidance of emergency department for consultation, and the information, reassurance and support provided to support self-management of symptoms. However, several factors influenced the users’ engagement with triage services, including confidence to articulate symptoms, limited opening hours, waiting times for initial triage or follow-up and digital literacy. Collectively, these factors contributed to delayed reporting or under-reporting of symptoms, undermining the potential impact of services. Studies included variable reporting of intervention characteristics, including the qualification of nurses delivering and leading services. ConclusionsFuture evaluations of triage services must give greater consideration to the characterisation of interventions to ensure transferability, including nursing roles and qualifications. To ensure effective intervention and optimal supportive care for symptom management, patients must be prepared to engage triage services early. Future evaluations must ensure the impact of digital literacy on engagement with, and experience of, virtual triage is investigated.

Examining HIV organizational structures and their influence on engagement with young Black gay, bisexual, and other men who have sex with men in Atlanta, Georgia

Young Black gay, bisexual, and other men who have sex with men (YB-GBMSM) are disproportionately impacted by HIV. Structural influences on these disparities, including characteristics of the various organizations that serve YB-GBMSM living with HIV, remain understudied. We drew on Weick’s model of organizing to conduct and analyze qualitative interviews with 28 HIV service providers representing healthcare and community-based organizations in Atlanta, Georgia. Enactment of HIV service provision was described as following simplified and standardized responses-defined as “rules”, and/or more dynamic exchanges to formulate responses -otherwise known as “communication behavior cycles” (CBCs). Rules, including patient quotas and limited hours of operation, were viewed as rigid, out-of-touch, and inhibiting engagement with YB-GBMSM. CBCs, such as patient feedback loops and rejection of traditional hierarchies, fostered creative insights to combating the epidemic and increased levels of cultural awareness and community buy-in. Organizations should strive to enact CBCs, to foster culturally congruent approaches to service delivery for YB-GBMSM.

Integration of Care in Complex and Fragmented Service Systems: Experiences of Staff in Flexible Assertive Community Treatment Teams.

Introduction:To provide more integrated care, several countries have implemented the Flexible Assertive Community Treatment (FACT) model. However, this model does not guarantee full integration, especially in complex and fragmented service systems like in Norway. Hence, we investigated which barriers that might reduce the potential for integrated care in the Norwegian system, as described by staff in FACT teams, and how they adjust their way of working to increase the opportunities for integration.Methods:Online focus group interviews involving 35 staff members of five Norwegian FACT teams were conducted using a semi-structured interview guide. The material was analysed using thematic text analysis.Results:Six themes described the barriers to integrated care in the service system: fragmentation, different legislation and digital systems, challenges in collaboration, bureaucracy and limited opening hours. Three themes described adjustments in the teams’ way of working to enhance integration: working as the responsible co-ordinator, being a collaborator, and the only entry channel into the service system.Conclusion:The FACT team staff described several barriers to integration within the system. However, they made some adjustments in their way of working that might provide opportunities for integrated care within complex and fragmented service systems.

Demand and supply-side barriers and opportunities to enhance access to healthcare for urban poor populations in Kenya: a qualitative study

ObjectiveTo explore the barriers to and options for improving access to quality healthcare for the urban poor in Nairobi, Kenya.Design and participantsThis was a qualitative approach. In-depth interviews (n=12), focus...

Abstract MP09: Partnering With Employers To Provide Worksite-based Health Assessments In Rural Communities

Introduction: Office-based healthcare delivery with limited hours of operation can be a deterrent to seeking medical care for many individuals. Innovative approaches to healthcare delivery, particularly health assessment and screenings, could improve patient engagement and ultimately yield better long-term public health outcomes. Hypothesis: Compared to national averages, elevated rates of undiagnosed and uncontrolled disease will be found among participants living in a rural area with known high endemic disease through worksite-based health assessments. Methods: Between December 2020 and October 2021, we partnered with 13 business for on-the-jobsite health screening clinics. Participants completed a series of questionnaires and a physical assessment. Disease screenings included diabetes, hypertension, kidney disease, cholesterol, sleep apnea, and stroke risk. Results were available immediately following the screening. Physicians conducted one-on-one consultations with participants to discuss their results and advise them, as needed, on treatment and management of their condition. Results: A total of 463 individuals (44.7% white) (54.4% male) were screened. On-site lab results identified 41 (9.0%) participants with an indicator of diabetes (HbA1c ≥6.5) that were previously undiagnosed*. An additional 44 (9.6%) participants had been previously diagnosed with diabetes, but testing results indicated their diabetes was not well controlled (HbA1c ≥6.5). Undiagnosed hypertension (SBP ≥140) was found in 114 (24.7%) participants and 93 (20.2%) participants had diagnosed but uncontrolled hypertension. We also identified 33 (15.9%) participants with indicators of chronic kidney disease (urine protein ≥1), 13 (3.9%) participants with high cholesterol (total cholesterol ≥240), 122 (26.3%) participants with moderate increased risk of heart attack or stroke (CHA 2 DS 2 -VASc ≥2), and 27 (22.0%) with moderate to severe risk of obstructive sleep apnea (STOP-BANG ≥4). Conclusion: Of over 450 individuals screened, nearly a quarter of participants revealed a moderate increased risk of heart attack or stroke. Nearly half of participants had uncontrolled or undiagnosed hypertension and twenty percent of participants suffered from uncontrolled or undiagnosed diabetes. Our mobile, on-the-jobsite health screening clinics provide patients with convenient, walk-in service, immediate results, and physician consultation as a bridge to accessing ongoing care. This screening strategy addresses issues of complexity, cost, and privacy and captures individuals who may otherwise underutilize or avoid engagement with the healthcare system. Longer-term follow-up is planned to determine the public health impact of these on-the-jobsite health screenings. *Percentage based off number screened per condition

Blood culture diagnostics: a Nordic multicentre survey comparison of practices in clinical microbiology laboratories

ObjectivesAccurate and rapid microbiological diagnostics are crucial to tailor treatment and improve outcomes in patients with severe infections. This study aimed to assess blood culture diagnostics in the Nordic countries and to compare them with those of a previous survey conducted in Sweden in 2013. MethodsAn online questionnaire was designed and distributed to the Nordic clinical microbiology laboratories (CMLs) (n = 76) in January 2018. ResultsThe response rate was 64% (49/76). Around-the-clock incubation of blood cultures (BCs) was supported in 82% of the CMLs (40/49), although in six of these access to the incubators around the clock was not given to all of the cabinets in the catchment area, and 41% of the sites (20/49) did not assist with satellite incubators. Almost half (49%, 24/49) of the CMLs offered opening hours for ≥10 h during weekdays, more commonly in CMLs with an annual output ≥30 000 BCs. Still, positive BCs were left unprocessed for 60–70% of the day due to restrictive opening hours. Treatment advice was given by 23% of CMLs (11/48) in ≥75% of the phone contacts. Rapid analyses (species identification and susceptibility testing with short incubation), performed on aliquots from positive cultures, were implemented in 18% of CMLs (9/49). Compared to 2013, species identification from subcultured colonies (<6 h) had become more common. ConclusionsCMLs have taken action to improve aspects of BC diagnostics, implementing satellite incubators, rapid species identification and susceptibility testing. However, the limited opening hours and availability of clinical microbiologists are confining the advantages of these changes.

How pharmacy can start to solve the inequity puzzle

How pharmacy can start to solve the inequity puzzle

Acceptability of an mHealth App That Provides Harm Reduction Services Among People Who Inject Drugs: Survey Study.

BackgroundHarm reduction services reduce the negative consequences of drug injection and are often embedded within syringe service programs (SSPs). However, people who inject drugs (PWID) suboptimally engage with such services because of stigma, fear, transportation restrictions, and limited hours of operation. Mobile health (mHealth) apps may provide an opportunity to overcome these barriers and extend the reach of SSPs beyond that of the traditional brick-and-mortar models.ObjectiveThis study aims to assess the prevalence of smartphone ownership, the level of comfort in providing the personal information required to use mHealth apps, and interest in using an mHealth app to access harm reduction services among PWID to guide the development of an app.MethodsWe administered a survey to 115 PWID who were enrolled via respondent-driven sampling from July 2018 to July 2019. We examined the extent to which PWID had access to smartphones; were comfortable in providing personal information such as name, email, and address; and expressed interest in various app-based services. We measured participant characteristics (demographics, health status, and behaviors) and used binary logistic and Poisson regressions to identify independent correlates of mHealth-related variables. The primary regression outcomes included summary scores for access, comfort, and interest. The secondary outcomes included binary survey responses for individual comfort or interest components.ResultsMost participants were White (74/105, 70.5%), male (78/115, 67.8%), and middle-aged (mean=41.7 years), and 67.9% (74/109) owned a smartphone. Participants reported high levels of comfort in providing personal information to use an mHealth app, including name (96/109, 88.1%), phone number (92/109, 84.4%), email (85/109, 77.9%), physical address (85/109, 77.9%), and linkage to medical records (72/109, 66.1%). Participants also reported strong interest in app-based services, including medication or sterile syringe delivery (100/110, 90.9%), lab or appointment scheduling (90/110, 81.8%), medication reminders (77/110, 70%), educational material (65/110, 59.1%), and group communication forums (64/110, 58.2%). Most participants were comfortable with the idea of home delivery of syringes (93/109, 85.3%). Homeless participants had lower access to smartphones (adjusted odds ratio [AOR] 0.15, 95% CI 0.05-0.46; P=.001), but no other participant characteristics were associated with primary outcomes. Among secondary outcomes, recent SSP use was positively associated with comfort with the home delivery of syringes (AOR 3.29, 95% CI 1.04-10.3 P=.04), and being older than 50 years was associated with an increased interest in educational materials (AOR 4.64, 95% CI 1.31-16.5; P=.02) and group communication forums (AOR 3.69, 95% CI 1.10-12.4; P=.04).ConclusionsOur findings suggest that aside from those experiencing homelessness or unstable housing, PWID broadly have access to smartphones, are comfortable with sharing personal information, and express interest in a wide array of services within an app. Given the suboptimal access to and use of SSPs among PWID, an mHealth app has a high potential to address the harm reduction needs of this vulnerable population.

The Effects of COVID-19 induced pandemic on the production, trade, and income of smallholder vegetable growers in Kathmandu Valley, Nepal

The COVID-19 pandemic is the biggest national health crisis in the Nepal's modern history, which has devastating impacts on the economy and the agricultural sector. To curtail the virus spread, the Government of Nepal announced a lockdown starting from 24 April 2020, encouraging producers, traders, processors, and consumers in the value chain to implement stay-at-home order and public health protocols, including social distancing, which impaired the overall food demand and supply systems of Kathmandu valley. This study assessed the effects of the COVID-19 pandemic in the production and distribution of vegetables in the Kathmandu valley. We made a scenario-based situation analysis of pre-COVID (Jan to March 2020) and COVID-19 pandemic induced lockdown (April to June 2020) situations.&nbsp; The study used a descriptive research design and employed multistage sampling techniques. One hundred forty-five vegetable growers were surveyed. Six focus group discussions were carried out between May to July 2020 in the three municipalities (Kathmandu- Chandragiri municipality; Lalitpur-Mahalaxmi municipality;Bhaktapur- Changunarayan municipality) of Kathmandu valley. The study showed that the lockdown to contain the spread of the virus had disrupted the entire vegetable value chains and food systems. Empirical data showed that the income of smallholders' vegetable growers was decreased by 66.1 percent due to an increase in input price (16.9 percent), a decrease in output price (62.67 percent), and low farm productivity (9.3 percent) in comparison with the average income during the pre-COVID situation. This paper has figured out the impact pathways that caused the income decline of vegetable growers. The primary constraints to smallholder producers were the absence of local aggregators followed by transportation barriers, limited market opening hours, and mobility obstruction and changed consumers' behavior due to lockdown. Majority of the farmers adjusted to the situations by selling their products in the regular wholesale and local markets at lower prices, free distribution to the local inhabitants, on-farm sale at a lesser price, and composting and dumping the surpluses.

Effects of COVID-19 induced pandemic on the production, trade, and income of smallholder vegetable growers in Kathmandu Valley, Nepal

This study assessed the effects of the COVID-19 pandemic on production, trade and income of smallholder vegetables growers in the Kathmandu valley, Nepal. We made a scenario-based situation analysis of pre-COVID (January to March 2020) and COVID-19 pandemic induced lockdown (April to June 2020) situations. The study used a descriptive research design and employed multistage sampling techniques. One hundred forty-five vegetable growers were surveyed and six focus group discussions were carried out between May to July 2020 in the three municipalities- Chandragiri, Mahalaxmi and Changunarayan of Kathmandu, Lalitpur and Bhaktapur districts respectively. The study showed that the income of smallholders' vegetable growers was decreased by 66.1 percent due to an increase in input price (16.9 percent), a decrease in output price (62.67 percent), and low farm productivity (9.3 percent) in comparison with the pre-COVID period. This paper has figured out the impact pathways that caused the income decline of vegetable growers. The primary constraints to smallholder producers were the absence of local aggregators followed by transportation barriers, limited market opening hours, and mobility obstruction and changed consumers' behavior due to lockdown. Majority of the farmers adjusted to the situations by selling their products at lower prices, free distribution to the local inhabitants, and composting and dumping the surpluses. The study concluded that this kind of analysis is necessary to develop resilient supply chains and extend appropriate support to the smallholder farmers who are critical actor to the supply chains.

Barriers to access and utilisation of HIV/STIs prevention and care services among trans-women sex workers in the greater Kampala metropolitan area, Uganda

BackgroundTrans-women sex workers bear the greatest brunt of HIV and other sexually transmitted infections (STI). Trans-women are 49 times more at risk of HIV infections compared to the general population. However, they remain underserved and continue to grapple with access to and utilisation of HIV/STI prevention services. This study explored barriers to access and utilisation of HIV/STI prevention services and associated coping mechanisms.MethodsThis exploratory qualitative study was conducted among trans-women sex workers in the Greater Kampala Metropolitan area, Uganda. A total of 22 in-depth interviews, 6 key informant interviews and 9 focus group discussions were conducted to obtain data on barriers to access and utilisation of HIV and other STI prevention and care services, and coping strategies of trans-women sex workers. Data were analysed through thematic analysis using a hybrid of inductive and deductive approaches.ResultsIndividual level barriers to access and utilisation of HIV/STI prevention and care services included internalised stigma and low socio-economic status. Healthcare system barriers included social exclusion and lack of recognition by other key population groups; stigmatisation by some healthcare providers; breach of confidentiality by some healthcare providers; limited hours of operation of some key population-friendly healthcare facilities; discrimination by straight patients and healthcare providers; stockout of STI drugs; inadequate access to well-equipped treatment centres and high cost of drugs. At community level, transphobia hindered access and utilisation of HIV/STI prevention and care services. The coping strategies included use of substitutes such as lotions, avocado or yoghurt to cope with a lack of lubricants. Herbs were used as substitutes for STI drugs, while psychoactive substances were used to cope with stigma and discrimination, and changing the dress code to hide their preferred gender identity.ConclusionsIndividual, community and healthcare system barriers hindered access and utilisation of HIV/STI prevention and care services among the trans-women sex workers. There is a need to create an enabling environment in order to enhance access to and utilisation of HIV/STI prevention and care services for trans-women sex workers through sensitisation of healthcare providers, other key population groups and the community at large on the transgender identity.